A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20191938Keywords:
Expectant management, Induction of labour, Mild gestational hypertensionAbstract
Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.
Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.
Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).
Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.
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References
Duley L. The global impact of pre-eclampsia and eclampsia. Seminars in Perinatology. 2009;33:130-7.
Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376(9741):631-44.
Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Kirmeyer S, Mathews TJ, et al. Births: final data for 2009. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2011;60(1):1-70.
Bhageerathy PS, Thomas V, Regi A, Jose R. Induction of labour versus conservative management for mild gestational hypertension at term. International Journal of Reproduction, Contraception, Obstet Gynecol. 2017;5(3):689-95.
Ganzevoort W, Sibai BM. Temporising versus interventionist management (preterm and at term). Best Pract Resea Clini Obstet Gynaecol. 2011;25(4):463-76.
Sibai BM. Management of late preterm and early-term pregnancies complicated by mild gestational hypertension/pre-eclampsia. In Seminars in Perinatology. 2011;35(5):292-6.
Khaskheli MN, Baloch S, Sheeba A, Baloch S, Khan F. Labour induction with Gestational Hypertension: A great obstetric challenge. Pak J Medi Scien. 2017;33(1):151.
Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, van den Berg PP, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial. The Lancet. 2009;374(9694):979-88.
Bangal VB, Giri PA, Mahajan AS. Maternal and fetal outcome in pregnancy induced hypertension: A study from rural Tertiary care teaching hospital in India. Int J Biomed Resea. 2011;2(12):595-9.
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